Impact of race and diagnostic label on older adults' emotions, illness beliefs, and willingness to help a family member with osteoarthritis.

OBJECTIVE: To examine how race and the diagnostic label of Osteoarthritis (OA) affects older adults' emotions, illness beliefs, and willingness to help a family member. METHODS: African American and White older adults were randomly assigned to read vignettes describing a sister suffering from chronic pain and disability, either with or without the OA label. Race × diagnostic label ANOVAs were conducted. RESULTS: Compared to Whites, African Americans were more optimistic that OA could improve with health care, and showed greater willingness to help their sister. The OA label had little impact on emotions, beliefs, or willingness to help. African Americans rated the sister as having more control of their problem than Whites without the OA label, but providing the diagnosis eliminated this difference. DISCUSSION: The diagnostic label of OA had little effect on these older adults, but racial differences indicate that cultural values regarding family caregiving are important in arthritis care.

Preferences for arthritis interventions: identifying similarities and differences among African Americans and whites with osteoarthritis.

OBJECTIVE: To determine if there are differences or similarities in arthritis intervention preferences and barriers to participation between African Americans and whites with osteoarthritis (OA). METHODS: Using a needs assessment survey, intervention preferences and barriers to participation in arthritis interventions among African American (n = 60) and white (n = 55) adults with self-reported doctor-diagnosed OA were examined. T-tests, chi-square tests, and multiple regression analyses adjusting for covariates were examined to determine race effects. RESULTS: While there were many similarities, African Americans were more likely to report cost (P < 0.01), lack of trust (P = 0.04), fear of being the only person of their race (P < 0.001), lack of recommendation from their doctor (P = 0.04), and lack of recommendation of a family member or friend (P = 0.02) as barriers to participating in a community-based self-management arthritis intervention. After adjusting for covariates, African Americans preferred interventions that provide information on arthritis-related internet sources (P = 0.04), solving arthritis-related problems (P = 0.04), and talking to family and friends about their condition (P = 0.02) in comparison to whites. African Americans also preferred an intervention with child care services provided (P < 0.01), with instructors and participants of the same race (P < 0.01 and P < 0.001, respectively) or sex (P < 0.001 and P = 0.03, respectively), that allows a friend (P = 0.001) or family member (P = 0.02) to attend, that is offered at a local church (P = 0.01) or clinic (P < 0.01), or that is mailed (P < 0.01). CONCLUSION: Findings suggest that similar interventions are preferred across racial groups, but some practical adaptations could be made to existing arthritis interventions to minimize barriers, increase cultural sensitivity, and offer programs that would be appealing to African Americans and whites with arthritis.

Marital Conflict Behaviors and Implications for Divorce over 16 Years.

This study examined self-reported marital conflict behaviors and their implications for divorce. Husbands and wives (N = 373 couples; 47% White American, 53% Black American) reported conflict behaviors in years 1, 3, 7, and 16 of their marriages. Individual behaviors (e.g., destructive behaviors) and patterns of behaviors between partners (e.g., withdrawal-constructive) in Year 1 predicted higher divorce rates. Wives' destructive and withdrawal behaviors decreased over time, whereas husbands' conflict behaviors remained stable. Husbands reported more constructive and less destructive behaviors than wives and Black American couples reported more withdrawal than White American couples. Findings support behavioral theories of marriage demonstrating that conflict behaviors predict divorce and accommodation theories indicating that conflict behaviors become less negative over time.

The impact of obesity and arthritis on active life expectancy in older Americans.

This article examines the relationship of obesity and arthritis to length of life and length of disabled life in older American men and women. Secondary data analysis is conducted on three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (n = 7,381). Using integrated Markov chains, total, active, and disabled life expectancy in Americans aged > or =70 is estimated, with and without obesity and arthritis. Results indicate that neither obesity nor arthritis is related to the length of life for older men and women, alone or in combination. However, both conditions are significantly individually associated with increased length of disabled life in older men (1.4 years attributable to obesity; 1.2 years to arthritis at age 70; P < 0.05) and women (1.7 years attributable to obesity; 2.1 years to arthritis at age 70; P < 0.05). In addition, the combination of the two is significantly related to decreased active life, with nearly 50 and 60% of remaining life for 70-year-old men and women lived with disability, respectively (P < 0.05). Coupled with the fact that both obesity and arthritis are growing in prevalence, these findings represent one of the few clearly negative health trends in older adults today. These results should provide incentives for health-care professionals to make concerted efforts to address both conditions in clinical settings.

Explaining the relationship between pain and depressive symptoms in African-American and white women with arthritis.

Arthritis is a common chronic illness that disproportionately affects women and African Americans and is often associated with depression. The mechanisms through which arthritis-related pain are associated with depression remain unclear. This study examined the relationship between arthritis-related pain and depressive symptoms to determine if functional impairment and sense of mastery mediated this relationship. Participants included 77 African-American and 98 white women with arthritis (aged 45-90) who completed structured questionnaires assessing pain, functional impairment, sense of mastery and depressive symptoms. Regression analyses showed that sense of mastery and functional impairment partially mediated the relationship between pain and depressive symptoms for whites such that the previously significant pain-depression relationship (beta = 0.40, p < 0.001) was no longer significant (beta = 0.05, p = 0.62). Only sense of mastery partially mediated between pain and depressive symptoms for African Americans. Again, the previously significant pain-depression relationship (beta = 0.32, p < 0.01) was reduced (beta = 0.16, p = 0.19). Implications of the study suggest that it is important for service providers and healthcare professionals to be aware of different lifetime experiences and perceptions of illness in order to better serve the needs of women from different race groups.

Racial differences in arthritis-related stress, chronic life stress, and depressive symptoms among women with arthritis: a contextual perspective.

OBJECTIVES: This study examined the effects of arthritis-related stress and chronic life stress on depressive symptoms among African Americans and Whites with arthritis. METHODS: Participants included 175 African American and White women (aged 45-90) who completed structured questionnaires assessing arthritis-related stress (i.e., pain, functional impairment, perceived stress), chronic life stress (i.e., discrimination, financial stress, life stressors), and well-being (i.e., depressive symptoms). RESULTS: African Americans reported more functional impairment and lower perceived arthritis stress, but more life stressors, financial stress, and discrimination, than Whites. Arthritis-related stress accounted for similar proportions of variance in depressive symptoms across African Americans (DeltaR2=.16, p<.001) and Whites (DeltaR2=.24, p<.001). However, chronic life stressors explained significantly more variance among African Americans (DeltaR2=.20, p<.001, vs DeltaR2=.06, p<.05). DISCUSSION: Findings demonstrate the importance of considering contextual factors influencing women's health and well-being, particularly for those women with a chronic illness, including arthritis. Although arthritis-related stressors may be the predominant factors affecting well-being for Whites with arthritis, well-being in African Americans with arthritis is also closely tied to broader life stressors. Results suggest the importance of looking beyond illness-specific stressors when studying aging and health.

Are behavioral interventions for arthritis effective with minorities? Addressing racial and ethnic diversity in disability and rehabilitation.

OBJECTIVE: To determine whether research evaluating the effectiveness of behavioral interventions for arthritis demonstrates that these interventions are effective with, and appropriately utilized by, minority participants. METHODS: A systematic review was conducted of arthritis intervention research from 1997 to 2008. For each article, information was gathered on the percentage of participants who were from different racial/ethnic groups, whether interventions were shown to be effective for minority participants, whether differential attrition analyses were conducted, whether efforts were reported in minority recruitment and retention, and whether attempts were made to make interventions culturally appropriate. RESULTS: We identified 25 randomized intervention studies. Of these, only 2 reported on whether the intervention was similarly effective for white and black patients (equal effectiveness was found), and 6 studies reported examining differences in attrition by race (higher attrition in nonwhites was found in 1 study). Most studies did not report the percentage of participants from specific minority groups, and in many studies the percentage of minority participants was small. No studies reported making systematic efforts to assure that interventions were culturally appropriate for minority participants. CONCLUSION: Minority patients with arthritis are at risk for higher levels of disability than white patients, but little is known about whether evidence-based interventions for arthritis are effective for culturally diverse patients. In addition, minority patients appear to be underrepresented in intervention research, and too little attention has been paid to minority recruitment and assuring that interventions are culturally appropriate for diverse patients.

Perceptions of Illness, coping, and well-being in persons with mild cognitive impairment and their care partners.

Despite greater attention to mild cognitive impairment (MCI), little is known about reactions to this potentially threatening diagnosis among persons with MCI (PWMCI) and their care partners. Psychologic reactions, perceptions of illness, and coping responses of 46 individuals recently diagnosed with MCI and 29 care partners were assessed with questionnaires assessing psychologic well-being, illness perceptions, coping, and perceived needs for services. Care partners and PWMCI report normal levels of psychologic well-being, showing less distress than is commonly found in Alzheimer disease (AD) caregivers. Problem-focused (eg, active coping) and emotion-focused coping strategies (eg, acceptance) were used more often than dysfunctional coping strategies (eg, self-distraction) by PWMCI and care partners. Both groups tended to minimize the likelihood of conversion to AD, and endorsed mental and physical exercise, optimism, dietary changes, and stress reduction as strategies to prevent conversion. Although PWMCI minimized their impairment, care partners reported providing an average of 24 hours per week of caregiving and reported that the PWMCI did need significant help with complex activities. Respondents reported using few formal services but they anticipate substantial future need for services. Results suggest that PWMCI and care partners are likely to minimize the threat of AD and to perceive that conversion is controllable and preventable with health promotion activities. Study implications for the development of intervention programs for PWMCI and their care partners are discussed.

Age differences in the pain-depression link for women with osteoarthritis. Functional impairment and personal control as mediators.

PURPOSE: This study examines functional impairment and personal control as mediators between pain and depressive symptoms in middle-aged and older women with osteoarthritis (OA). METHOD: Ninety-nine middle-aged and older women with OA completed face-to-face interviews to assess pain, functional impairment, personal control, depressive symptoms, and self-rated health. RESULTS: Controlling for self-rated health, functional impairment mediated the relationship between pain and depressive symptoms for middle-age women but not for older women. Alternately, personal control was a mediator for older women but not for middle-aged women. CONCLUSIONS: Functional limitations at least partially explain the relationship between pain and depression for middle-aged women who are juggling many roles and do not expect trouble with daily activities. For older women, functional limitations are expected, but personal control becomes more important. Implications for intervention are discussed.

Impact of the diagnostic label of osteoarthritis on perceptions of disability and willingness to help a parent in African Americans and whites.

OBJECTIVE: Family members are central to arthritis care, but little is known about public perceptions of osteoarthritis (OA) and how cultural diversity affects these perceptions. We examined the effects of participant race and diagnostic label of OA on family members' perceptions and willingness to help a parent with OA. METHODS: A total of 105 young adult African American and 308 young adult white participants were randomly assigned to read 1 of 2 vignettes (OA label versus no label) describing an older mother with marked pain and disability. Effects for race and diagnostic label were examined. RESULTS: Participants who were told that the mother had OA were more likely to believe the mother's problems were due to illness, but were less likely to believe that better health care would improve her condition than participants not told a diagnosis. African Americans attributed less blame to the mother, showed less anger, more sympathy, and were more willing to help compared with whites. CONCLUSION: The finding that the OA label leads to pessimism concerning the benefits of health care for a parent suggests a need for public education on the effectiveness of arthritis care. Race differences in perceptions of the parent and willingness to provide care are consistent with previous literature on race and family caregiving, and indicate that cultural values regarding family caregiving may be important in arthritis care. Family members could serve as important allies for elderly individuals with OA, and public health efforts should not just target older adults but should also provide information on arthritis care for families.

Patients' ratings of quality and satisfaction with care at the end of life.

OBJECTIVE: To elicit ratings of quality and satisfaction with care from medical inpatients, especially those near the end of life. METHODS: We conducted a cross-sectional survey of 84 seriously ill medical inpatients at 2 academic medical centers. Forty-five had do-not-resuscitate orders. Patients were interviewed using a valid and reliable instrument, the Quality of End-of-Life Care and Satisfaction With Treatment scale (scored from 1.0-5.0) and standard measures of symptoms, anxiety, depression, and delirium. RESULTS: Mean patient ratings of quality of care were higher regarding physicians than nurses (4.39 vs 4.24; P =.01). Mean patient ratings of satisfaction with physicians were also higher, but not significantly (4.53 vs 4.43; P =.32). In analysis of variance models, patient ratings of physician quality were lowest for patients with do-not-resuscitate orders who were treated by a house-staff service compared with other patients (P =.01). These patients were also least satisfied with their physicians (P =.03). Nondepressed patients with private attending physicians rated nursing quality the highest (P =.16). These patients also reported the highest satisfaction with nurses (P =.002). Quality and satisfaction were not related to severity of illness, and pain was only weakly associated with satisfaction with physicians. CONCLUSIONS: Patients with do-not-resuscitate orders who were treated by a house-staff service gave the lowest ratings of physician quality and satisfaction. Only private patients who were not depressed were highly satisfied with their nursing care. Further study is required to better understand these findings and whether they are amenable to quality improvement.

A scale for measuring patient perceptions of the quality of end-of-life care and satisfaction with treatment: the reliability and validity of QUEST.

We report on the adaptation and evaluation of a previously developed patient-centered instrument that we call the Quality of End-of-life care and Satisfaction with Treatment (QUEST) scale. In a separate group of 30 inpatients, test-retest reliability for QUEST items ranged from 63% agreement (kappa = 0.43) to 93% agreement (kappa = 0.86) and construct validity was evidenced by correlations with a somewhat related satisfaction scale ranging from 0.38 to 0.47. QUEST was then administered to 206 consecutive medical inpatients (or their surrogates) with DNR orders and to a comparison group of 51 medical inpatients without DNR orders at 2 academic medical centers. Among these main study patients, internal consistency was reflected by Cronbach alphas of 0.88 to 0.93. QUEST scores showed modest inverse correlations with severity of symptoms, but were uncorrelated with severity of illness, anxiety, or depression, suggesting an appropriate relationship to symptom control but divergence of the underlying construct from degree of physical illness or affective state. QUEST scores were lower for patients with DNR orders compared to those without DNR orders (P = 0.02 to 0.06). Surrogate ratings of satisfaction and quality were uncorrelated with patient ratings. Although preliminary, these findings suggest that QUEST may be useful in assessing quality and satisfaction with the care rendered by physicians and nurses to hospitalized patients at the end of life.